[NPInfo] Prolotherapy

Fri Feb 29 08:57:33 PST 2008

I know a colleague that is an MD with sports medicine speciality.  He  does 
this  a lot and has had great results.  However, He cautioned at  a conference 
on pain that you need a practitioner that has a lot of experience  and has 
done it thousands of times.  I recently saw a 2 day course to learn  how to do 
it.  So make sure your nephew checks the credentials of the  person performing 
it.
Gaylene Adams ARNP-C

In a message dated 2/29/2008 6:35:51 A.M. Pacific Standard Time,  
tedscott59 at cox.net writes:

Here is  a description of the injections from the prolotherapy.org web  site:

What Is In Prolotherapy Injection?
Most of this information is  derived from the writings of Allen R. Banks,
Ph.D. Proliferants used in  Prolotherapy are basically substances that lead
to new collagen formation.  Collagen is the naturally occurring protein in
the body that makes up  ligaments and tendons. Prolotherapy solutions help
strengthen these  structures by initiating the first step in the
wound-healing cascade, which  is local inflammation. Once the inflammation
has begun, fibroblasts are  stimulated. These are the cells that make the
collagen. New collagen is  produced, making the ligaments and tendons
stronger and tighter. The  solutions vary in the mechanism by which they
cause localized inflammation  but, in general, they all act by causing
localized tissue damage or  irritation, which initiates the influx of
inflammatory cells. The exception  to this rule is sodium morrhuate, which
probably acts more as a chemotactic  (attraction) factor.

Osmotic Proliferants (Solutions)
Osmotic  proliferant solutions are the most commonly used proliferants and
include  dextrose and glycerin. These are injected and cause a higher  osmotic
(concentrated) gradient outside of the cells than inside of the  cells. This
causes cells to lose water and break. These broken cell  particles stimulate
an influx of inflammatory cells and initiate the  wound-healing cascade to
the specific area. Osmotic proliferants are  water-soluble and thus, very
safe. Being water-soluble means that whatever  the body does not need is
excreted out in the urine and is not stored in  the fatty tissue of the body.
Other proliferants in this class include the  minerals zinc, calcium, and
manganese. The minerals are also cofactors for  various enzymes. For
instance, manganese is needed for the enzyme  superoxide dismutase, which
helps the antioxidant status of the body. Since  some people believe
arthritis is from oxidative damage, some  Prolotherapists, including those at
Caring Medical and Rehabilitation  Services, use manganese in the solution
for arthritic  patients.

Irritants
These are substances that are known to directly  alter the proteins on the
surfaces of the cells. They act by attaching  themselves or their byproducts
to the surfaces of the cells at the  injection sites and they either damage
the cells directly or render them  reactive to the immune system. In either
case, the immune cells are  attracted to the area and start the immune
response. The irritants that are  used most commonly in Prolotherapy include
dextrose, phenol, guaiacol,  tannic acid, and plasma QU (quinine, urea). The
Prolotherapy solution used  in the two double-blinded studies was P2G, which
included phenol, glycerin,  and glucose. We use an alkaline extract of the
pitcher plant called  Sarapin. The exact mechanism of how Sarapin relieves
pain is unknown but is  felt to be due to the ammonium sulfate concentrate in
the extract of the  plant. It is plausible that this ammonium sulfate
compound, or some yet  unidentifiable biological agent in the pitcher plant,
causes a gentle  irritation which adds to the proliferant effect of the
solution when  Sarapin is added.

Particulates
The most common particulate  proliferant used is pumice flour. These small
particles on the order of one  micron, are notable for their ability to
attract macrophages, which  immediately phagocytize (eat up) the particles.
Once the macrophages are at  the injection site and ingesting pumice
granules, they are actively  secreting polypeptide growth factors, which
ultimately result in collagen  tissue growth.

Chemotactics
Chemotactics are proliferants that  directly attract the immune cells to the
injured area. Sodium morrhuate is  thought to work in this way. Sodium
morrhuate is the sodium salt of the  fatty acid component derived from cod
liver oil. Cold water fish oils are  rich in polyunsaturated fatty acids,
such as arachidonic acid. These  compounds serve as the direct precursors to
inflammation mediators. In this  way, Sodium Morrhuate may directly attract
the immune system to the area.  Sodium morrhuate most resembles Sylnasol, one
of the first proliferants  ever used in Prolotherapy.

Growth Factors
Growth factors represent  the future of Prolotherapy. As modern medicine
makes advances in the  regenerative mechanisms of the human body, many new
growth factors are  being discovered. Their effects are being tested as they
directly stimulate  the repair of various cells, organs, and diseases.
Polypeptide growth  factors act directly upon fibroblasts (which make
collagen). Epidermal  growth factor, insulin-like growth factors, fibroblast
growth factors, and  platelet-derived growth factors are now available for
research and testing  purposes. Physicians are already using Growth Hormone
injections directly  into joints to help regenerate cartilage. Many of these
growth factors are  available in homeopathic form to be taken orally during
the Prolotherapy  treatment course. As medical research continues, it is most
assuredly  certain that these growth factors will be incorporated into the
technique  of Prolotherapy.

Summary
The basic mechanism of Prolotherapy is  simple. A substance is injected,
which leads to local inflammation. The  localized inflammation triggers a
wound-healing cascade, resulting in the  deposition of new collagen. New
collagen shrinks as it matures. The  shrinking collagen tightens the ligament
that was injected and makes it  stronger. Prolotherapy has the potential of
being 100 percent effective at  eliminating sports injuries and chronic pain,
but depends upon the  technique of the individual Prolotherapist. The most
important aspect is  injecting enough of the solution into the injured and
weakened area. If  this is done, the likelihood of success is excellent.

I am not sure  if I would recommend or reject this alternative therapy
without some  further research. It sounds like Homeopathy is some respects.

Ted Scott  NP-C

-----Original Message-----
From: npinfo-bounces at nurse.net  [mailto:npinfo-bounces at nurse.net] On Behalf
Of Jeff and Linda  Bocchetto
Sent: Friday, February 29, 2008 3:01 AM
To: npinfo
Subject:  [NPInfo] Prolotherapy

Hi all;
My nephew called me last night and  asked me what I knew regarding
Prolotherapy. I have never heard of it and  wondered if any one in the group
has had any experience with it, good or  bad. All I know at this point is: it
is some type of treatment to stimulate  tendons/ligaments to heal themselves
stronger after injecting an irritant  into them.
Linda B,  NP
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